CAN A PHYSICIAN RECOGNIZE AN OLDER DRIVER WITH INCREASED CRASH RISK POTENTIAL

OBJECTIVE: To identify factors in a medical examination that distingui sh convicted older drivers with traffic violations from other drivers. DESIGN: Matched case-control study. SETTING: Two counties in Sweden. SUBJECTS: Thirty-seven drivers older than age 65, whose driving licens es have been temporarily suspended, each matched to one control subjec t based on age, sex, type of driving license, year of first license, l iving area, educational level, and annual distance driven. MEASUREMENT S: Case and control subjects were compared with respect to medical his tory, medication use, blood tests, drawing and memory tests, Mini-Ment al State Examination, medical status findings, visual acuity, and brai n imaging procedures. MAIN RESULTS: The group of drivers with suspende d driving licenses did not differ from matched controls with respect t o visual acuity or presence of cardiovascular diseases. However, perso ns with suspended driving licenses were more likely than control subje cts to have suspected or mild dementia (P < .010) and to perform less well on two easily administrated screening tests: copying a cube (P < .010) and 5-item recall (P < .010). Case subjects with crashes had sig nificantly more cardiovascular diseases than case subjects with other moving violations (P < .050). These case subjects with crashes also ha d significantly more cognitive impairments than control subjects witho ut crashes as shown by a higher clinical dementia rating score (CDR) ( P < .001), lower score on the Mini-Mental State Examination (MMSE) (P < .050), and lower level of performance in the copying task (cube) (P < .050) and 5-item recall test (P < .010). They also had evidence of g reater cognitive impairment than those case subjects with other moving violations. CONCLUSIONS: Visual acuity and common medical examination did not distinguish convicted older drivers with crashes or other mov ing violations from controls. There was evidence that even mild cognit ive impairment contributed to the risk of losing a driving license bec ause of crashes.